Increase in the incidence of MRSA in Sweden - Solo in the fight against the "Super Bug"

There were two massive outbreaks of the dreaded "Super Bug", MRSA, in 2005 at the University Hospital in Linköping, Sweden. Both patients and personnel were struck, wards were closed and admission of new patients was stopped. We went there to find out what has happened since then.

When we arrive at the intensive care unit (ICU), we are met by the physiotherapist Jenny Örman, together with her two colleagues, nurse Karin Strömberg and assistant nurse Birgitte Leidström, who are responsible for hygiene on the ward.

– During the first big outbreak in 2005, we had just one case of MRSA (Methicillin-resistant Staphylococcus aureus) on our ward. So we did OK, says Karin Strömberg.

But one case is one too many, say Karin and Birgitte. The patients on the ICU are more susceptible to infections because their immune system often is weakened; they can have sores and in general a state of health that is worse than normal. And because of their state of health, an infection is a great threat, especially if the infection cannot be treated with antibiotics, as in the case of MRSA.

Not following the rules

The hospitals in Sweden have long had clear hygiene rules, but the inability to prevent the spread of MRSA has been interpreted as if these rules have not always been followed. Therefore, they have gone in for information and training in, for instance, Linköping. Each ward also has one or several persons who are responsible for hygiene. On the ICU, this is Karin and Birgitte.

– As responsible for hygiene on the ward we are the people our colleagues turn to if they have questions on hygiene. If we can't answer the questions, we take them to the hygiene department at the hospital.

The hygiene department works as support for the entire hospital. Among other things, they do hygiene rounds together with the responsible person for hygiene on the wards in order to find shortcomings and improvement possibilities.

Increase in MRSA in spite of new routines

But in the end, it is up to each of the employees at the hospital to follow the basic hygiene routines, in all situations.

– Each patient should be treated as if he or she were contagious, irrespective of whether they have MRSA or not, so that neither the patients nor the personnel are struck by any disease, Birgitte clarifies.

In spite of the fact that hygiene issues have been the source of quite lively discussions throughout the country, the number of reported cases of the "Super Bug" continues to rise in the country as a whole. Therefore, the Swedish Institute for Infectious Disease Control has continued focus on the development, even if we in Sweden, with our approx. 1000 cases, are relatively spared in comparison with the rest of Europe.

Physical therapy at the ICU

To be thorough with hygiene is a condition for preventing the spread of infections. But by making the patients less susceptible to infections, one can also contribute to a decrease in the incidents and thereby reduce the risk of spreading infection.

At the ICU the physiotherapist Jenny Örman works with precisely this principle. She says that they work a lot with breathing gymnastics, mobilisation and cough support.

– Mobilisation is very important in order to reduce the problem with mucus in the lungs, which is a common consequence of surgery. Training and treatment contribute to prevent, for instance, pneumonia, says Jenny. For the physiotherapists, also, the same strict rules on hygiene apply. They also have to consider how the aids are used, so that they don't themselves become a hygiene risk.

– We often say "let the alcohol flow!", Jenny, Karin and Birgitte all say laughingly. But all aids, for instance textiles, cannot be cleaned with disinfectants. The routines for treating textiles are different from hospital to hospital and also between different wards in the same hospital.

It depends on the kind of textiles and how dirty they are.

Using aids

At the ICU in Linköping they have reached the conclusion that their slings and lift sheets cannot be washed, mainly because it would take several weeks before they would get them back.

– We can't make it that long without our slings, we don't have that many in store, says Karin. In order to combine the needs of the organization with the hygiene requirements, the solution was to use the Solo slings and lift sheets which are made of disposable fabric.

– We use them every day for the patients when we check their weight and thereby their fluid balance; this is very important. In order to maintain hygiene, each patient has his/her own lift sheet, says Karin. In this way, they always have new and clean lifting accessories which are personally assigned and are disposed of when the patient goes home.

The disposable slings are cheaper to buy and the hospital doesn't have to pay for cleaning them, which compensates for the increased consumption.

In addition to the lift slings, they also use lift vests for mobilisation training and slings for transfer of patients.

Never perfect

Now, two years after the big outbreaks of the infection, when all of the excitement has abated and all of the routines have settled, it is obvious that there were shortcomings.

– They were probably more careless before, but now they think more, says the physiotherapist Jenny Örman.

But in an organisation like the one on ICU, it is not always sure that one has the time to think beforehand.

– It is clear that sometimes it is urgent and then you don't have time. Then we have to do the best we can afterwards, Birgitte Leidström concludes.